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PapersSizeatbirthandresiliencetoeffectsofpoorlivingconditionsinadultlife:longitudinalstudyDJPBarker,TForsén,AUutela,COsmond,JGErikssonAbstractObjectiveTodeterminewhethermenwhogrewslowlyinuteroorduringinfancyaremorevulnerabletothelatereffectsofpoorlivingconditionsoncoronaryheartdisease.
DesignFollowupstudyofmenforwhomthereweredataonbodysizeatbirthandgrowthandsocialclassduringchildhood,educationallevel,andsocialclassandincomeinadultlife.
SettingHelsinki,Finland.
Participants3676menwhowerebornduring1934-44,attendedchildwelfareclinicsinHelsinki,werestillresidentinFinlandin1971,andforwhomdatafromthe1980censuswereavailable.
MainoutcomemeasuresHospitaladmissionforordeathfromcoronaryheartdisease.
ResultsMenwhohadlowsocialclassorlowhouseholdincomeinadultlifehadincreasedratesofcoronaryheartdisease.
Thehazardratioamongmenwiththelowestannualincome(140(15700)45/7341.
000.
002111-140(15700)61/7761.
34(0.
91to1.
96)96-110(12400)41/5951.
26(0.
82to1.
92)75-95(10700)64/7471.
52(1.
03to2.
22)118(13300)1.
001.
74(1.
03to2.
94)2.
05(1.
20to3.
50)87-118(13300)0.
92(0.
39to2.
14)1.
79(1.
07to2.
99)1.
63(0.
97to2.
74)26.
0(n=2154)Hazardratio(95%CI)Unadjusted(adjusted)PvaluefortrendHazardratio(95%CI)Unadjusted(adjusted)PvaluefortrendInfancyFather'ssocialclass:Uppermiddle1.
000.
06(0.
41*)0.
76(0.
32to1.
84)0.
006(0.
02*)Lowermiddle1.
52(0.
71to3.
27)1.
05(0.
49to2.
27)Labourer1.
86(0.
94to3.
68)1.
60(0.
81to3.
16)EducationLevelofeducation:High1.
000.
0040.
60(0.
30to1.
20)0.
007Middle1.
29(0.
73to2.
27)1.
50(0.
88to2.
55)Low2.
00(1.
17to3.
42)1.
47(0.
86to2.
51)Adultlife(1980)Socialclass:Higherofficial1.
00140(15700)1.
00<0.
0001(0.
0001)1.
19(0.
65to2.
19)0.
75(0.
84)111-140(15700)1.
54(0.
83to2.
87)1.
42(0.
78to2.
57)96-110(12400)1.
07(0.
51to2.
22)1.
66(0.
90to3.
07)76-95(10700)2.
07(1.
13to3.
79)1.
44(0.
79to2.
62)<75(8400)2.
58(1.
45to4.
60)1.
37(0.
75to2.
51)*Adjustedforadultsocialclass.
Adjustedforfather'ssocialclass.
Table4Hazardratiosforcoronaryheartdiseaseinmenwithponderalindexatbirth<26kg/m3,accordingtoadultsocialclassandchangesinbodymassindex(BMI)betweenages1and12yearsSocialclassChangeinSDscoreforBMIDecrease*IncreaseHigherofficial1.
38(0.
55to3.
52)1.
00Lowerofficial1.
14(0.
38to3.
40)1.
84(0.
70to4.
85)Selfemployed0.
69(0.
09to5.
62)2.
93(0.
86to10.
01)Labourer2.
18(0.
88to5.
39)3.
78(1.
68to8.
53)*P=0.
24fortrend.
P<0.
0001fortrend.
Papers3BMJVOLUME3231DECEMBER2001bmj.
comon8November2020byguest.
Protectedbycopyright.
http://www.
bmj.
com/BMJ:firstpublishedas10.
1136/bmj.
323.
7324.
1273on1December2001.
DownloadedfromInfantgrowthandsocialclassAshaspreviouslybeenshown,wefoundthathavingafatherwithlowsocialclassincreasedtheriskofcoron-aryheartdiseaseindependentlyofaman'sownsocialclass.
10–13Growthduringinfancywasreducedinfamiliesoflowsocialclass,andpoorinfantgrowthisassociatedwithincreasedriskofdisease,possiblythroughalteredlivergrowthandconsequentre-programmingoflipidmetabolismandbloodcoagulation.
1415Theeffectsoflowsocialclassoncoronaryheartdisease,however,wereonlypartlyexplainedbytheireffectoninfantgrowth.
Itsothereffectscouldbelinkedtoitsstrongassociationwithpooreducationalattainment.
EducationWefoundthatpooreducationalattainmentwasassoci-atedwithlatercoronaryheartdisease.
Menwhoachievedonlylowlevelsofeducationhadreducedinfantgrowth,butthisexplainedonlyasmallpartoftheassociation.
OnepossibleexplanationhasbeensuggestedbyafollowupstudyofchildrenborninAberdeen,Scotland.
16Thosewhohadlowerscoresinamentalabilitytestat12yearsofagediedyounger.
WhalleyandDrearyproposedthatperformanceinintelligencetestsmightreflectgeneralaspectsofchild-hoodfitnessrelatedtolongtermhealth.
Greaterintel-ligenceandhigherlevelsofeducationcouldalsobeassociatedwithhealthierbehaviourinadultlife.
LivingstandardsinadultlifeAsexpected,lowsocialclassandlowincomewereassociatedwithincreasedratesofcoronaryheartdisease.
71718Wefound,however,thattheseeffectswerestrongerinmenwhowerethinatbirth,especiallyiftheyhadhadacceleratedweightgaininchildhood.
Taxablehouseholdincomewasstronglyrelatedtoeducationalattainment.
Wefoundthatbetteredu-cationalattainmentprotectedmenfromtheharmfuleffectsoflowincome.
Thewayinwhichlowincomemayincreasecardiovascularriskiscontroversial.
Lynchetalhaveemphasisedthematerialconsequencesoflowincomeonlivingconditions.
19Whilebettereduca-tionmayenablepeopletoreducetheeffectsoflowincomeontheirlivingstandards,itissurprisingthatwefoundnoeffectofincomeonceeducationwastakenintoaccount.
MarmotandWilkinsonhaveemphasisedthepsychosocialconsequencesofalowpositioninthesocialhierarchy,asindicatedbylowincome,andsuggestedthatperceptionsoflowsocialstatusandlackofsuccessleadtochangesinneuroendocrinepathwaysandhencetodisease.
20Ourfindingsseemconsistentwiththishypothesis,althoughtheypointtotheimportanceofahierarchydefinedbyeducationratherthanincome.
Thehypothesiscouldalsoexplainwhy,inourstudy,lowincomewasassociatedwithcoronaryheartdiseaseonlyinavulnerablegroupdefinedbylowratesofintrauterinegrowth.
Peoplewhoaresmallatbirthareknowntohavepersistingalterationsinresponsestostress,includingraisedserumcortisolconcentrations.
21Rapidchildhoodweightgainmayexacerbatetheadverseeffectsofsmallsizeatbirth.
22ConclusionOurresultsshowthatstudiesofthedevelopmentalori-ginsofcoronaryheartdiseasemayrevealnewbiologi-calpathwaysthroughwhichsocialinfluencesaffecttheriskofdisease.
23Peoplewhoserateofgrowthinfetallife,infancy,andchildhooddiffersfromthenormremainbiologicallydifferentandareatincreasedriskofcoronaryheartdisease.
Socialinfluencesthataltergrowthmaythereforealtertheriskofdisease.
Conversely,alteredearlygrowthmayincreasevulner-abilitytotheeffectsofpoorlivingstandardsinadultlife.
Therefore,improvementsinfetal,infant,andchildgrowthmaypreventcoronaryheartdiseaseinthenextgenerationbyimprovingthebody'sfitnessandmakingitresilienttolatersocialadversity.
WethankTerttuNopanen,TiinaSaarinen,Hillevifverstrm-Anttila,ArjaPurtonen,TiinaValle,HannaPehkonen,andUllaTarvainenforabstractingthedatafromtherecords.
SigridRos-tenwasresponsiblefordatamanagement.
LiisaToivanencoor-dinateddataabstraction.
Contributors:Alltheauthorstookpartinthedesignandanalysisofthestudyandjointlywrotethepaper.
ThedataabstractionandlinkageweresupervisedbyJGEandTF.
JGE,CO,andDJPBwillactasguarantorsforthepaper.
Funding:BritishHeartFoundation,JahnssonFoundation,FinskaLkaresllskapet,NovoFoundation.
Competinginterests:Nonedeclared.
1MarmotMG,ShipleyMJ,RoseG.
Inequalitiesindeath—specificexplana-tionsofageneralpatternLancet1984;i:1003-6.
2WaalerHT.
Height,weightandmortality.
TheNorwegianexperience.
ActaMedScandSuppl1984;679:1-56.
3BarkerDJP,WinterPD,OsmondC,MargettsB,SimmondsSJ.
Weightininfancyanddeathfromischaemicheartdisease.
Lancet1989;ii:577-80.
4LeonDA,LithellHO,VageroD,KoupilovaI,MohsenR,BerglundL,etal.
Reducedfetalgrowthrateandincreasedriskofdeathfromischaemicheartdisease:cohortstudyof15000Swedishmenandwomenborn1915-29.
BMJ1998;317:241-5.
5ErikssonJG,ForsenT,TuomilehtoJ,WinterPD,OsmondC,BarkerDJP.
Catch-upgrowthinchildhoodanddeathfromcoronaryheartdisease:longitudinalstudy.
BMJ1999;318:427-31.
6ErikssonJG,ForsenT,TuomilehtoJ,OsmondC,BarkerDJP.
Earlygrowthandcoronaryheartdiseaseinlaterlife:longitudinalstudy.
BMJ2001;322:949-53.
7AchesonD.
Independentinquiryintoinequalitiesinhealth.
London:HMStationeryOffice,1998.
8HavenH.
EducationinFinland.
Helsinki:PainoCenterrOy,1998(OfficialStatisticsofFinland).
9CoxDR.
Regressionmodelsandlife-tables.
JRStatSoc[SerB]1972;34:187-220.
10ForsdahlA.
ArepoorlivingconditionsinchildhoodandadolescenceanimportantriskfactorforarterioscleroticheartdiseaseBrJPrevSocMed1977;31:91-5.
11LynchJW,KaplanGA,CohenRD,KauhanenJ,WilsonTW,SmithNL,etal.
ChildhoodandadultsocioeconomicstatusaspredictorsofmortalityinFinland.
Lancet1994;343:524-7.
12WannametheeSG,WhincupPH,ShaperG,WalkerM.
Influenceoffathers'socialclassoncardiovasculardiseaseinmiddle-agedmen.
Lancet1996;348:1259-63.
13DaveySmithG,HartC,BlaneD,HoleD.
Adversesocioeconomiccondi-tionsinchildhoodandcausespecificadultmortality:prospectiveobser-vationalstudy.
BMJ1998;316:1631-5.
14FallCHD,BarkerDJP,OsmondC,WinterPD,ClarkPMS,HalesCN.
Relationofinfantfeedingtoadultserumcholesterolconcentrationanddeathfromischaemicheartdisease.
BMJ1992;304:801-5.
WhatisalreadyknownonthistopicPeoplewhogrowslowlyinuteroandduringinfancyremainbiologicallydifferentthroughtheirlivesSuchpeopleareatincreasedriskofcoronaryheartdiseaseWhatthisstudyaddsAmongmenwhowerethinatbirththeriskofcoronaryheartdiseaseisfurtherincreasediftheyhavepoorlivingstandardsinadultlifeOthermentendtoberesilienttotheadverseeffectsofpoorlivingstandardsPapers4BMJVOLUME3231DECEMBER2001bmj.
comon8November2020byguest.
Protectedbycopyright.
http://www.
bmj.
com/BMJ:firstpublishedas10.
1136/bmj.
323.
7324.
1273on1December2001.
Downloadedfrom15BarkerDJP,MeadeTW,FallCHD,LeeA,OsmondC,PhippsK,etal.
RelationoffetalandinfantgrowthtoplasmafibrinogenandfactorVIIconcentrationsinadultlife.
BMJ1992;304:148-52.
16WhalleyLJ,DearyIJ.
LongitudinalcohortstudyofchildhoodIQandsur-vivaluptoage76.
BMJ2001;322:819-22.
17MarmotM,McDowellME.
Mortalitydeclineandwideningsocialinequalities.
Lancet1986;ii:274-6.
18MacintyreK,StewartS,ChalmersJ,PellJ,FinlaysonA,BoydJ,etal.
Rela-tionbetweensocioeconomicdeprivationanddeathfromafirstmyocar-dialinfarctioninScotland:populationbasedanalysis.
BMJ2001;322:1152-3.
19LynchJW,DaveySmithG,KaplanGA,HouseJS.
Incomeinequalityandmortality:importancetohealthofindividualincome,psychosocialenvi-ronment,ormaterialconditions.
BMJ2000;320:1200-4.
20MarmotM,WilkinsonRG.
Psychosocialandmaterialpathwaysintherelationbetweenincomeandhealth:aresponsetoLynchetal.
BMJ2001;322:1233-6.
21PhillipsDIW,WalkerBR,ReynoldsRM,FlanaghanDEH,WoodPJ,OsmondC,etal.
Lowbirthweightpredictselevatedplasmacortisolcon-centrationsinadultsfrom3populations.
Hypertension2000;35:1301-6.
22ForsenT,ErikssonJ,TuomilhetoJ,ReunanenA,OsmondC,BarkerDJP.
Thefetalandchildhoodgrowthofpersonswhodeveloptype2diabetes.
AnnInternMed2000;133:176-82.
23DickensP.
Linkingthesocialandnaturalsciences:iscapitalmodifyinghumanbiologyinitsownimage.
Sociology2001;35:93-110.
(Accepted29August2001)Papers5BMJVOLUME3231DECEMBER2001bmj.
comon8November2020byguest.
Protectedbycopyright.
http://www.
bmj.
com/BMJ:firstpublishedas10.
1136/bmj.
323.
7324.
1273on1December2001.
Downloadedfrom
DesignFollowupstudyofmenforwhomthereweredataonbodysizeatbirthandgrowthandsocialclassduringchildhood,educationallevel,andsocialclassandincomeinadultlife.
SettingHelsinki,Finland.
Participants3676menwhowerebornduring1934-44,attendedchildwelfareclinicsinHelsinki,werestillresidentinFinlandin1971,andforwhomdatafromthe1980censuswereavailable.
MainoutcomemeasuresHospitaladmissionforordeathfromcoronaryheartdisease.
ResultsMenwhohadlowsocialclassorlowhouseholdincomeinadultlifehadincreasedratesofcoronaryheartdisease.
Thehazardratioamongmenwiththelowestannualincome(140(15700)45/7341.
000.
002111-140(15700)61/7761.
34(0.
91to1.
96)96-110(12400)41/5951.
26(0.
82to1.
92)75-95(10700)64/7471.
52(1.
03to2.
22)118(13300)1.
001.
74(1.
03to2.
94)2.
05(1.
20to3.
50)87-118(13300)0.
92(0.
39to2.
14)1.
79(1.
07to2.
99)1.
63(0.
97to2.
74)26.
0(n=2154)Hazardratio(95%CI)Unadjusted(adjusted)PvaluefortrendHazardratio(95%CI)Unadjusted(adjusted)PvaluefortrendInfancyFather'ssocialclass:Uppermiddle1.
000.
06(0.
41*)0.
76(0.
32to1.
84)0.
006(0.
02*)Lowermiddle1.
52(0.
71to3.
27)1.
05(0.
49to2.
27)Labourer1.
86(0.
94to3.
68)1.
60(0.
81to3.
16)EducationLevelofeducation:High1.
000.
0040.
60(0.
30to1.
20)0.
007Middle1.
29(0.
73to2.
27)1.
50(0.
88to2.
55)Low2.
00(1.
17to3.
42)1.
47(0.
86to2.
51)Adultlife(1980)Socialclass:Higherofficial1.
00140(15700)1.
00<0.
0001(0.
0001)1.
19(0.
65to2.
19)0.
75(0.
84)111-140(15700)1.
54(0.
83to2.
87)1.
42(0.
78to2.
57)96-110(12400)1.
07(0.
51to2.
22)1.
66(0.
90to3.
07)76-95(10700)2.
07(1.
13to3.
79)1.
44(0.
79to2.
62)<75(8400)2.
58(1.
45to4.
60)1.
37(0.
75to2.
51)*Adjustedforadultsocialclass.
Adjustedforfather'ssocialclass.
Table4Hazardratiosforcoronaryheartdiseaseinmenwithponderalindexatbirth<26kg/m3,accordingtoadultsocialclassandchangesinbodymassindex(BMI)betweenages1and12yearsSocialclassChangeinSDscoreforBMIDecrease*IncreaseHigherofficial1.
38(0.
55to3.
52)1.
00Lowerofficial1.
14(0.
38to3.
40)1.
84(0.
70to4.
85)Selfemployed0.
69(0.
09to5.
62)2.
93(0.
86to10.
01)Labourer2.
18(0.
88to5.
39)3.
78(1.
68to8.
53)*P=0.
24fortrend.
P<0.
0001fortrend.
Papers3BMJVOLUME3231DECEMBER2001bmj.
comon8November2020byguest.
Protectedbycopyright.
http://www.
bmj.
com/BMJ:firstpublishedas10.
1136/bmj.
323.
7324.
1273on1December2001.
DownloadedfromInfantgrowthandsocialclassAshaspreviouslybeenshown,wefoundthathavingafatherwithlowsocialclassincreasedtheriskofcoron-aryheartdiseaseindependentlyofaman'sownsocialclass.
10–13Growthduringinfancywasreducedinfamiliesoflowsocialclass,andpoorinfantgrowthisassociatedwithincreasedriskofdisease,possiblythroughalteredlivergrowthandconsequentre-programmingoflipidmetabolismandbloodcoagulation.
1415Theeffectsoflowsocialclassoncoronaryheartdisease,however,wereonlypartlyexplainedbytheireffectoninfantgrowth.
Itsothereffectscouldbelinkedtoitsstrongassociationwithpooreducationalattainment.
EducationWefoundthatpooreducationalattainmentwasassoci-atedwithlatercoronaryheartdisease.
Menwhoachievedonlylowlevelsofeducationhadreducedinfantgrowth,butthisexplainedonlyasmallpartoftheassociation.
OnepossibleexplanationhasbeensuggestedbyafollowupstudyofchildrenborninAberdeen,Scotland.
16Thosewhohadlowerscoresinamentalabilitytestat12yearsofagediedyounger.
WhalleyandDrearyproposedthatperformanceinintelligencetestsmightreflectgeneralaspectsofchild-hoodfitnessrelatedtolongtermhealth.
Greaterintel-ligenceandhigherlevelsofeducationcouldalsobeassociatedwithhealthierbehaviourinadultlife.
LivingstandardsinadultlifeAsexpected,lowsocialclassandlowincomewereassociatedwithincreasedratesofcoronaryheartdisease.
71718Wefound,however,thattheseeffectswerestrongerinmenwhowerethinatbirth,especiallyiftheyhadhadacceleratedweightgaininchildhood.
Taxablehouseholdincomewasstronglyrelatedtoeducationalattainment.
Wefoundthatbetteredu-cationalattainmentprotectedmenfromtheharmfuleffectsoflowincome.
Thewayinwhichlowincomemayincreasecardiovascularriskiscontroversial.
Lynchetalhaveemphasisedthematerialconsequencesoflowincomeonlivingconditions.
19Whilebettereduca-tionmayenablepeopletoreducetheeffectsoflowincomeontheirlivingstandards,itissurprisingthatwefoundnoeffectofincomeonceeducationwastakenintoaccount.
MarmotandWilkinsonhaveemphasisedthepsychosocialconsequencesofalowpositioninthesocialhierarchy,asindicatedbylowincome,andsuggestedthatperceptionsoflowsocialstatusandlackofsuccessleadtochangesinneuroendocrinepathwaysandhencetodisease.
20Ourfindingsseemconsistentwiththishypothesis,althoughtheypointtotheimportanceofahierarchydefinedbyeducationratherthanincome.
Thehypothesiscouldalsoexplainwhy,inourstudy,lowincomewasassociatedwithcoronaryheartdiseaseonlyinavulnerablegroupdefinedbylowratesofintrauterinegrowth.
Peoplewhoaresmallatbirthareknowntohavepersistingalterationsinresponsestostress,includingraisedserumcortisolconcentrations.
21Rapidchildhoodweightgainmayexacerbatetheadverseeffectsofsmallsizeatbirth.
22ConclusionOurresultsshowthatstudiesofthedevelopmentalori-ginsofcoronaryheartdiseasemayrevealnewbiologi-calpathwaysthroughwhichsocialinfluencesaffecttheriskofdisease.
23Peoplewhoserateofgrowthinfetallife,infancy,andchildhooddiffersfromthenormremainbiologicallydifferentandareatincreasedriskofcoronaryheartdisease.
Socialinfluencesthataltergrowthmaythereforealtertheriskofdisease.
Conversely,alteredearlygrowthmayincreasevulner-abilitytotheeffectsofpoorlivingstandardsinadultlife.
Therefore,improvementsinfetal,infant,andchildgrowthmaypreventcoronaryheartdiseaseinthenextgenerationbyimprovingthebody'sfitnessandmakingitresilienttolatersocialadversity.
WethankTerttuNopanen,TiinaSaarinen,Hillevifverstrm-Anttila,ArjaPurtonen,TiinaValle,HannaPehkonen,andUllaTarvainenforabstractingthedatafromtherecords.
SigridRos-tenwasresponsiblefordatamanagement.
LiisaToivanencoor-dinateddataabstraction.
Contributors:Alltheauthorstookpartinthedesignandanalysisofthestudyandjointlywrotethepaper.
ThedataabstractionandlinkageweresupervisedbyJGEandTF.
JGE,CO,andDJPBwillactasguarantorsforthepaper.
Funding:BritishHeartFoundation,JahnssonFoundation,FinskaLkaresllskapet,NovoFoundation.
Competinginterests:Nonedeclared.
1MarmotMG,ShipleyMJ,RoseG.
Inequalitiesindeath—specificexplana-tionsofageneralpatternLancet1984;i:1003-6.
2WaalerHT.
Height,weightandmortality.
TheNorwegianexperience.
ActaMedScandSuppl1984;679:1-56.
3BarkerDJP,WinterPD,OsmondC,MargettsB,SimmondsSJ.
Weightininfancyanddeathfromischaemicheartdisease.
Lancet1989;ii:577-80.
4LeonDA,LithellHO,VageroD,KoupilovaI,MohsenR,BerglundL,etal.
Reducedfetalgrowthrateandincreasedriskofdeathfromischaemicheartdisease:cohortstudyof15000Swedishmenandwomenborn1915-29.
BMJ1998;317:241-5.
5ErikssonJG,ForsenT,TuomilehtoJ,WinterPD,OsmondC,BarkerDJP.
Catch-upgrowthinchildhoodanddeathfromcoronaryheartdisease:longitudinalstudy.
BMJ1999;318:427-31.
6ErikssonJG,ForsenT,TuomilehtoJ,OsmondC,BarkerDJP.
Earlygrowthandcoronaryheartdiseaseinlaterlife:longitudinalstudy.
BMJ2001;322:949-53.
7AchesonD.
Independentinquiryintoinequalitiesinhealth.
London:HMStationeryOffice,1998.
8HavenH.
EducationinFinland.
Helsinki:PainoCenterrOy,1998(OfficialStatisticsofFinland).
9CoxDR.
Regressionmodelsandlife-tables.
JRStatSoc[SerB]1972;34:187-220.
10ForsdahlA.
ArepoorlivingconditionsinchildhoodandadolescenceanimportantriskfactorforarterioscleroticheartdiseaseBrJPrevSocMed1977;31:91-5.
11LynchJW,KaplanGA,CohenRD,KauhanenJ,WilsonTW,SmithNL,etal.
ChildhoodandadultsocioeconomicstatusaspredictorsofmortalityinFinland.
Lancet1994;343:524-7.
12WannametheeSG,WhincupPH,ShaperG,WalkerM.
Influenceoffathers'socialclassoncardiovasculardiseaseinmiddle-agedmen.
Lancet1996;348:1259-63.
13DaveySmithG,HartC,BlaneD,HoleD.
Adversesocioeconomiccondi-tionsinchildhoodandcausespecificadultmortality:prospectiveobser-vationalstudy.
BMJ1998;316:1631-5.
14FallCHD,BarkerDJP,OsmondC,WinterPD,ClarkPMS,HalesCN.
Relationofinfantfeedingtoadultserumcholesterolconcentrationanddeathfromischaemicheartdisease.
BMJ1992;304:801-5.
WhatisalreadyknownonthistopicPeoplewhogrowslowlyinuteroandduringinfancyremainbiologicallydifferentthroughtheirlivesSuchpeopleareatincreasedriskofcoronaryheartdiseaseWhatthisstudyaddsAmongmenwhowerethinatbirththeriskofcoronaryheartdiseaseisfurtherincreasediftheyhavepoorlivingstandardsinadultlifeOthermentendtoberesilienttotheadverseeffectsofpoorlivingstandardsPapers4BMJVOLUME3231DECEMBER2001bmj.
comon8November2020byguest.
Protectedbycopyright.
http://www.
bmj.
com/BMJ:firstpublishedas10.
1136/bmj.
323.
7324.
1273on1December2001.
Downloadedfrom15BarkerDJP,MeadeTW,FallCHD,LeeA,OsmondC,PhippsK,etal.
RelationoffetalandinfantgrowthtoplasmafibrinogenandfactorVIIconcentrationsinadultlife.
BMJ1992;304:148-52.
16WhalleyLJ,DearyIJ.
LongitudinalcohortstudyofchildhoodIQandsur-vivaluptoage76.
BMJ2001;322:819-22.
17MarmotM,McDowellME.
Mortalitydeclineandwideningsocialinequalities.
Lancet1986;ii:274-6.
18MacintyreK,StewartS,ChalmersJ,PellJ,FinlaysonA,BoydJ,etal.
Rela-tionbetweensocioeconomicdeprivationanddeathfromafirstmyocar-dialinfarctioninScotland:populationbasedanalysis.
BMJ2001;322:1152-3.
19LynchJW,DaveySmithG,KaplanGA,HouseJS.
Incomeinequalityandmortality:importancetohealthofindividualincome,psychosocialenvi-ronment,ormaterialconditions.
BMJ2000;320:1200-4.
20MarmotM,WilkinsonRG.
Psychosocialandmaterialpathwaysintherelationbetweenincomeandhealth:aresponsetoLynchetal.
BMJ2001;322:1233-6.
21PhillipsDIW,WalkerBR,ReynoldsRM,FlanaghanDEH,WoodPJ,OsmondC,etal.
Lowbirthweightpredictselevatedplasmacortisolcon-centrationsinadultsfrom3populations.
Hypertension2000;35:1301-6.
22ForsenT,ErikssonJ,TuomilhetoJ,ReunanenA,OsmondC,BarkerDJP.
Thefetalandchildhoodgrowthofpersonswhodeveloptype2diabetes.
AnnInternMed2000;133:176-82.
23DickensP.
Linkingthesocialandnaturalsciences:iscapitalmodifyinghumanbiologyinitsownimage.
Sociology2001;35:93-110.
(Accepted29August2001)Papers5BMJVOLUME3231DECEMBER2001bmj.
comon8November2020byguest.
Protectedbycopyright.
http://www.
bmj.
com/BMJ:firstpublishedas10.
1136/bmj.
323.
7324.
1273on1December2001.
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BuyVM($5/月）不限流量流媒体优化VPS主机 1GB内存
BuyVM商家属于比较老牌的服务商，早年有提供低价年付便宜VPS主机还记得曾经半夜的时候抢购的。但是由于这个商家风控非常严格，即便是有些是正常的操作也会导致被封账户，所以后来陆续无人去理睬，估计被我们风控的抢购低价VPS主机已经手足无措。这两年商家重新调整，而且风控也比较规范，比如才入手他们新上线的流媒体优化VPS主机也没有不适的提示。目前，BuyVM商家有提供新泽西、迈阿密等四个机房的VPS主机...
Megalayer（159元 ）年付CN2优化带宽VPS
Megalayer 商家我们还算是比较熟悉的，商家主要业务方向是CN2优化带宽、国际BGP和全向带宽的独立服务器和站群服务器，且后来也有增加云服务器（VPS主机）业务。这次中秋节促销活动期间，有发布促销活动，这次活动力度认为还是比较大的，有提供香港、美国、菲律宾的年付VPS主机，CN2优化方案线路的低至年付159元。这次活动截止到10月30日，如果我们有需要的话可以选择。第一、特价限量年付VPS主...
Sharktech$129/月，1Gbps不限流量，E5-2678v3(24核48线程)
Sharktech最近洛杉矶和丹佛低价配置大部分都无货了，只有荷兰机房还有少量库存，商家又提供了两款洛杉矶特价独立服务器，价格不错，CPU/内存/硬盘都是高配，1-10Gbps带宽不限流量最低129美元/月起。鲨鱼机房(Sharktech)我们也叫它SK机房，是一家成立于2003年的老牌国外主机商，提供的产品包括独立服务器租用、VPS主机等，自营机房在美国洛杉矶、丹佛、芝加哥和荷兰阿姆斯特丹等，主...
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